OBJECTIVE

Seeking a position where I can combine my 29 years of Healthcare experience and customer service expertise.

HIGHLIGHTS OF QUALIFICATIONS

Strong verbal and written communication skills, ability to prioritize multiple projects, ability to work independently as well as within a group, excellent organizational skills, responsible, trustworthy, respects authority, good interpersonal relation skills, excellent customer service skills

EMPLOYMENT EXPERIENCE

United Healthcare

Sr. Provider Service Advocate 10/2016-present

Responsible in responding to an average of 15 calls per day from healthcare providers to include: physicians’ offices and clinics. Create and offer guidance in assisting the providers a solution beneficial to the health plan and providers. Questions commonly asked are benefit eligibility, authorizations for benefits and billing and payments. Document in the Call system for claims and eligibility (CSP) programs using clear and concise language.

Key Accomplishments:

Developed a listing of products and product knowledge to best serve the providers/customers of the health plan.

Delivery of information provided in a caring manner to strengthen positive relationships.

Alohacare

Customer Service Claims Specialist 8/2010 - 10/1/2016

Analyzes and facilitates resolution to escalated claims issues by researching, analyzing and resolving complex problems dealing with fund recovery due to overpayments or underpayments, contract loads, rates, and language interpretation pertaining to appeals, grievances, and eligibility. Proactively identifies education and improvement opportunities when providing resolve to providers to strengthen the Network and provide First Call Resolution. Manages the implementation of new provider contracts ensuring all necessary information is collected and analyzed so providers can be credentialed, loaded, and notified within a timely manner. Analyzes operational issues with regard to territory providers and compliance to health plan programs and policies and assist in the development of solutions. Assists with recruitment of key providers to join health plan network including coordination and distribution of recruitment packages.

Key Accomplishments:

Serves as lead claims adjuster for the Customer Service and Provider Relations Departments.

Serves as liaison between Corporate Finance Department for claim recovery and adjustments.

Dave’s Ice Cream Factory

Office Adminstration 9/2009 – 8/2010

Managed office operations including administrative support including answering phones to assist with customer inquiries and complaints. Additionally handled monthly sales reports, and completing daily invoices of purchases and collection of on-site sales.

Key Accomplishments:

Long’s Drugs

Cashier 10/2007 – 1/2009

Performed all retail duties including, sales, stocking, and providing excellent customer service. This included processing payments, cash handling, answering product questions, and handling customer issues.

Kaiser Permanente

Emergency Room Business Service Clerk, SR 1/1998 – 12/2006

Responsible for reviewing the documentation of patient services. Communicates and requests patient information with regard to hospital privacy policies. Assists nursing staff as requested with delegated tasks to support the patient experience.

Key Accomplishments:

Trained new employees

Serves as a point person for job progress and performance reviews.

EDUCATION

Penn Foster

Pharmacy Technician

Certification of Completion – 2011

Sacred Hearts Academy

Diploma – 1974

OTHER SKILLS

QNXT

Microsoft Word-Business letters, memorandums, tables, envelopes

Microsoft Excel-Build, edit, format worksheets and charts

Ten-Key Electronic Calculator

Filing-Alphabetical, numerical, and chronological

Basic Record Keeping-cash and banking procedures, financial reports and payroll

Typewriter-Business letters, memorandums, envelopes

Human Relations-Interpersonal Relations Skills

Office Machines - Fax, Copier, Printer

Keyboarding-55 wpm

References

Available upon request

Contact this candidate